Spinal cord tumor

Overview

A spinal tumor is a growth that develops within your spinal canal or within the bones of your spine. A spinal cord tumor, also called an intradural tumor, is a spinal tumor that that begins within the spinal cord or the covering of the spinal cord (dura). A tumor that affects the bones of the spine (vertebrae) is called a vertebral tumor.

Spinal cord tumors may be classified as one of three different types depending on where they occur relative to the protective membranes of the spinal cord.

These are the main types of intradural tumors:

• Intramedullary tumors begin in the cells within the spinal cord itself, such as gliomas, astrocytomas or ependymomas.
• Extramedullary tumors grow in either the membrane surrounding the spinal cord or the nerve roots that reach out from the spinal cord. Although they don't begin within the spinal cord itself, these types of tumors may affect spinal cord function by causing spinal cord compression and other problems. Examples of extramedullary tumors that can affect the spinal cord include meningiomas, neurofibromas, schwannomas and nerve sheath tumors.

Tumors from other parts of the body can spread (metastasize) to the vertebrae, the supporting network around the spinal cord or, in rare cases, the spinal cord itself.

Spinal tumors or growths of any kind can lead to pain, neurological problems and sometimes paralysis. A spinal tumor can be life-threatening and cause permanent disability.

Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications.

Symptoms

Spinal cord tumors can cause different signs and symptoms, especially as tumors grow. The tumors may affect your spinal cord or the nerve roots, blood vessels or bones of your spine. Signs and symptoms may include:

• Pain at the site of the tumor due to tumor growth
• Back pain, often radiating to other parts of your body
• Feeling less sensitive to pain, heat and cold
• Loss of bowel or bladder function
• Difficulty walking, sometimes leading to falls
• Back pain that's worse at night
• Loss of sensation or muscle weakness, especially in your arms or legs
• Muscle weakness , which may be mild or severe, in different parts of your body

Back pain is a common early symptom of spinal tumors. Pain may also spread beyond your back to your hips, legs, feet or arms and may worsen over time — even with treatment.

Spinal tumors progress at different rates depending on the type of tumor.

When to see a doctor

There are many causes of back pain, and most back pain isn't caused by a tumor. But because early diagnosis and treatment are important for spinal tumors, see your doctor about your back pain if:

• It's persistent and progressive
• It's not activity related
• It gets worse at night
• You have a history of cancer and develop new back pain
• You have other symptoms of cancer, such as nausea, vomiting or dizziness

Seek immediate medical attention if you experience:

• Progressive muscle weakness or numbness in your legs or arms
• Changes in bowel or bladder function

Causes

It's not clear why most spinal tumors develop. Experts suspect that defective genes play a role. But it's usually not known whether such genetic defects are inherited or simply develop over time. They might be caused by something in the environment, such as exposure to certain chemicals. In some cases, however, spinal cord tumors are linked to known inherited syndromes, such as neurofibromatosis 2 and von Hippel-Lindau disease.

Risk factors

Spinal cord tumors are more common in people who have:

• Neurofibromatosis 2. In this hereditary disorder, benign tumors develop on or near the nerves related to hearing. This may lead to progressive hearing loss in one or both ears. Some people with neurofibromatosis 2 also develop spinal canal tumors.
• Von Hippel-Lindau disease. This rare, multisystem disorder is associated with blood vessel tumors (hemangioblastomas) in the brain, retina and spinal cord and with other types of tumors in the kidneys or adrenal glands.

Complications

Spinal tumors can compress spinal nerves, leading to a loss of movement or sensation below the location of the tumor. This can sometimes cause changes in bowel and bladder function. Nerve damage may be permanent.

However, if caught early and treated aggressively, it may be possible to prevent further loss of function and regain nerve function. Depending on its location, a tumor that presses against the spinal cord itself may be life-threatening.

Diagnosis

Spinal tumors sometimes might be overlooked because they're not common and their symptoms resemble those of more common conditions. For that reason, it's especially important that your doctor know your complete medical history and perform both general physical and neurological exams.

If your doctor suspects a spinal tumor, these tests can help confirm the diagnosis and pinpoint the tumor's location:

• Spinal magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to produce accurate images of your spine, spinal cord and nerves. MRI is usually the preferred test to diagnose tumors of the spinal cord and surrounding tissues. A contrast agent that helps highlight certain tissues and structures may be injected into a vein in your hand or forearm during the test.

  Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound it makes disturbing. But you're usually given earplugs to help with the noise, and some scanners are equipped with televisions or headphones. If you're very anxious, ask about a mild sedative to help calm you. In certain situations, a general anesthetic may be necessary.

• Computerized tomography (CT). This test uses a narrow beam of radiation to produce detailed images of your spine. Sometimes it's combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. A CT scan is only rarely used to help diagnose spinal tumors.
• Biopsy. The only way to determine the exact type of a spinal tumor is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options.

Treatment

Ideally, the goal of spinal tumor treatment is to eliminate the tumor completely, but this goal may be complicated by the risk of permanent damage to the spinal cord and surrounding nerves. Doctors also must take into account your age and overall health. The type of tumor and whether it arises from the structures of the spine or spinal canal or has spread to your spine from elsewhere in your body also must be considered in determining a treatment plan.

Treatment options for most spinal tumors include:

• Monitoring. Some spinal tumors may be discovered before they cause symptoms — often when you're being evaluated for another condition. If small tumors aren't growing or pressing on surrounding tissues, watching them carefully may be all that's needed.

  During observation, your doctor will likely recommend periodic CT or MRI scans at an appropriate interval to monitor the tumor.

• Surgery.This is often the treatment of choice for tumors that can be removed with an acceptable risk of spinal cord or nerve injury damage.

  Newer techniques and instruments allow neurosurgeons to reach tumors that were once considered inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumor from healthy tissue.

  Doctors also can monitor the function of the spinal cord and other important nerves during surgery, thus minimizing the chance of injuring them. In some instances, very high-frequency sound waves might be used during surgery to break up tumors and remove the fragments.

  But even with the latest technological advances in surgery, not all tumors can be totally removed. When the tumor can't be removed completely, surgery may be followed by radiation therapy or chemotherapy or both.

  Recovery from spinal surgery may take weeks or longer, depending on the procedure. You may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.

• Radiation therapy. This may be used to eliminate the remnants of tumors that remain after surgery, to treat inoperable tumors or to treat those tumors where surgery is too risky.

  Medications may help ease some of the side effects of radiation, such as nausea and vomiting.

  Sometimes, your radiation therapy regimen may be adjusted to help minimize the amount of healthy tissue that's damaged and to make the treatment more effective. Modifications may range from simply changing the dosage of radiation to using sophisticated techniques such as 3-D conformal radiation therapy.

• Chemotherapy. A standard treatment for many types of cancer, chemotherapy uses medications to destroy cancer cells or stop them from growing. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with radiation therapy.

  Side effects may include fatigue, nausea, vomiting, increased risk of infection and hair loss.

• Other drugs. Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either after surgery or during radiation treatments.

  Although corticosteroids reduce inflammation, they are usually used only for short periods to avoid serious side effects such as muscle weakness, osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.

Alternative medicine

Although there aren't any alternative medicines that have been proved to cure cancer, some complementary or alternative treatments may help relieve some of your symptoms.

One such treatment is acupuncture. During acupuncture treatment, a practitioner inserts tiny needles into your skin at precise points. Research shows that acupuncture may be helpful in relieving nausea and vomiting. Acupuncture might also help relieve certain types of pain in people with cancer.

Be sure to discuss the risks and benefits of complementary or alternative treatment that you're thinking of trying with your doctor. Some treatments, such as herbal remedies, could interfere with medicines you're taking.

Coping and support

Learning that you have a spinal tumor can be overwhelming. But you can take steps to cope after your diagnosis. Consider trying to:

• Find out all you can about your specific spinal tumor. Write down your questions and bring them to your appointments. As your doctor answers your questions, take notes or ask a friend or family member to come along to take notes.

  The more you and your family know and understand about your care, the more confident you'll feel when it comes time to make treatment decisions.

• Get support. Find someone you can share your feelings and concerns with. You may have a close friend or family member who is a good listener. Or speak with a clergy member or counselor.

  Other people with spinal tumors may be able to offer unique insights. Ask your doctor about support groups in your area. Online discussion boards, such as those offered by the Spinal Cord Tumor Association, are another option.

• Take care of yourself. Choose a healthy diet rich in fruits, vegetables and whole grains whenever possible. Check with your doctor to see when you can start exercising again. Get enough sleep so that you feel rested.

  Reduce stress in your life by taking time for relaxing activities, such as listening to music or writing in a journal.

Preparing for an appointment

If you have signs and symptoms that are common to spinal tumors — such as persistent, unexplained back pain, weakness or numbness in your legs, or changes in your bowel or bladder function, call your doctor promptly.

After your doctor examines you, you may be referred to a doctor who is trained to diagnose and treat cancer (oncologist), brain and spinal cord conditions (neurologist, neurosurgeon or spine surgeon), or disorders of the bones (orthopedic surgeon).

Here's some information to help you get ready for your appointment, and what to expect from the doctor.

What you can do

• Write down any symptoms you've been experiencing and for how long.
• List your key medical information, including all conditions you have and the names of any prescription and over-the-counter medications you're taking.
• Note any family history of brain or spinal tumors, especially in a first-degree relative, such as a parent or sibling.
• Take a family member or friend along. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

• What may be causing my symptoms?
• Are there any other possible causes?
• What kinds of tests do I need? Do these tests require any special preparation?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Should I see a specialist?

Questions to ask an oncologist or neurologist include:

• Do I have a spinal tumor?
• What type of tumor do I have?
• How will the tumor grow over time?
• What might be the consequences?
• What are the goals of my treatment?
• Am I a candidate for surgery? What are the risks?
• Am I a candidate for radiation? What are the risks?
• Is there a role for chemotherapy?
• What treatment approach do you recommend?
• If the first treatment isn't successful, what will we try next?
• What is the long-term outlook for my condition?
• Do I need a second opinion?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional questions that may come up during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Thinking about your answers ahead of time can help you make the most of your appointment. A doctor who sees you for a possible spinal tumor may ask:

• What are your symptoms?
• When did you first notice these symptoms?
• Have your symptoms gotten worse over time?
• If you have pain, where does the pain seem to start?
• Does the pain spread to other parts of your body?
• Have you participated in any activities that might explain the pain, such as a new exercise or a long stretch of gardening?
• Have you experienced any weakness or numbness in your legs?
• Have you had any difficulty walking?
• Have you had any problems with your bladder or bowel function?
• Have you been diagnosed with any other medical conditions?
• Are you currently taking any over-the-counter or prescription medications?
• Do you have any family history of noncancerous or cancerous spinal tumors?